Do French lay people and health professionals find it acceptable to breach confidentiality to protect a patient’s wife from a sexually transmitted disease?

• Published in: Journal of medical ethics Vol. 32; no. 7; pp. 414 - 419
• Main Authors: Guedj, M, Sastre, M T Muñoz, Mullet, E, Sorum, P C
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Institute of Medical Ethics 01.07.2006; BMJ Publishing Group; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adolescent; Adult; Attitude of Health Personnel; Attitude to Health; Behavior; Bioethics; Breach of contract; Care and treatment; Cluster Analysis; Cognitive science; Confidentiality; Disclosure; Duty to warn; Ethical codes; Family physicians; Female; France; HIV; Human immunodeficiency virus; Humanities and Social Sciences; Humans; Infections; Intention; Interpersonal Relations; Judgment; Male; Medical ethics; Medical personnel; Middle Aged; Murders & murder attempts; Patient confidentiality; Patients; Physicians; Practice; Professional ethics; Professionals; Psychologists; Psychology; Research Ethics; Risk factors; Severity of Illness Index; Sexual Behavior; sexually transmitted disease; Sexually transmitted diseases; Sexually Transmitted Diseases - psychology; Sexually Transmitted Diseases - transmission; Spouses; STD; Time Factors; France; United Kingdom > UK; United States > US
• DOI: 10.1136/jme.2005.012195
• ISSN: 0306-6800

Objective: To determine under what conditions lay people and health professionals find it acceptable for a physician to breach confidentiality to protect the wife of a patient with a sexually transmitted disease (STD). Methods: In a study in France, breaching confidentiality in 48 scenarios were accepted by 144 lay people, 10 psychologists and 7 physicians. The scenarios were all possible combinations of five factors: severity of the disease (severe, lethal); time taken to discuss this with (little time, much time); intent to inform the spouse about the disease (none, one of these days, immediately); intent to adopt protective behaviours (no intent, intent); and decision to consult an expert in STDs (yes, no), 2×2×3×2×2. The importance and interactions of each factor were determined, at the group level, by performing analyses of variance and constructing graphs. Results: The concept of breaching confidentiality to protect a wife from her husband’s STD was favoured much more by lay people and psychologists than by physicians (mean ratings 11.76, 9.28 and 2.90, respectively, on a scale of 0–22). The patient’s stated intentions to protect his wife and to inform her of the disease had the greatest impact on acceptability. A cluster analysis showed groups of lay participants who found breaching confidentiality “always acceptable” (n = 14), “depending on the many circumstances” (n = 87), requiring “consultation with an expert” (n = 30) and “never acceptable (n = 13)”. Conclusions: Most people in France are influenced by situational factors when deciding if a physician should breach confidentiality to protect the spouse of a patient infected with STD.